Meniscal Root Tears

Description of Meniscal Root Tears

Both the medial and lateral menisci have a stout attachment at their very posterior aspects, which are called the root attachments. These root attachments are important because they hold the meniscus in place, provides stability to the circumferential hoop fibers of the meniscus, and prevents meniscal extrusion.

When there is a tear of the meniscal root, it has been demonstrated on biomechanical testing that it is equivalent to having the whole meniscus removed. Thus, a tear of the meniscal root is considered a very serious condition.

Coronal view MRI scan demonstrating a posterior horn medial meniscus root tear. The meniscus is torn off its attachment site and tends to sublux posteromedially. This meniscal extrusion can lead to a nonfunctional medial meniscus and the early development of osteoarthritis.

CLICK IMAGE TO ENLARGE

There are two different group of patients who suffer meniscal root tears:

The first group consists of athletes in their 20s who sustain the tear with trauma. This could include an injury to the ACL, PCL, and other associated ligament combinations. In these circumstances, the meniscal root is commonly torn along with the ligament, and it is recommended to perform a concurrent meniscal root repair. Failure to repair the meniscal root tear in these circumstances can lead to the development of osteoarthritis, failure of a cruciate ligament reconstruction graft, and other problems further down the line.

The second group of patients who commonly tear their meniscal root is adults in their 50s. The consequences of a meniscal root tear appear to be much more severe in this age group. A meniscal root tear, which can occur with minor or seemingly trivial trauma, with a pop in the back of their knee with deep flexion, squatting and lifting, and other activities, can be quite severe. It is in this group of patients for which the rapid development of osteoarthritis can occur. In some of these patients, rather significant bone swelling, insufficiency fractures, and the appearance of osteonecrosis (avascular necrosis), can obscure one to seeing that it was caused by meniscal root tear.

Have you sustained a meniscal root tear?

There are two ways to initiate a consultation with Dr. LaPrade:

You can provide current X-rays and/or MRIs for a clinical case review with Dr. LaPrade.

MRI Diagnostic

Meniscal Root Tear Meniscal root tears can be seen on coronal, axial and sagittal MRI views. On the sagittal view, as seen in Figure C, there is a “ghost sign” which is indicative of meniscal root tear. A normal, healthy meniscus should look like a dark black triangle; however, as this figure shows the meniscus is much lighter or “ghosted” representing the root tear.

Meniscus Root Tear – Axial MRI View

Sagittal MRI view of a meniscal root tear.

CLICK IMAGE TO ENLARGE

Axial MRI View of Meniscal Root Tear

CLICK IMAGE TO ENLARGE

Ghost Sign Meniscal Root Tear

Sagittal MRI view there is a “ghost sign” which is indicative of meniscal root tear.

CLICK IMAGE TO ENLARGE

How to Read a MRI of a Meniscal Root Tear

Treatment for Meniscal Root Tears

The treatment of meniscal root tears in older patients can be very difficult. This is because they are not commonly diagnosed until the progression of arthritis is more severe. Due to the increasing knowledge that these tears can lead to rather progressive arthritis, one should consider an attempt at a meniscal root repair at the first signs of the development of pain and swelling with activities, which usually indicates the progression of arthritis, joint space narrowing, or any bony edema of the affected compartment on MRI scans. A concurrent distal femoral or proximal tibial osteotomy may also be indicated if the patient is malaligned to unload the affected compartment.

Meniscal root tears have only been noted as a significant pathology over the last 5 to 6 years. Research into the problem is ongoing. Our lab has noted that radial tears adjacent to the root attachment, known as a radial root tear, can also cause the same problems as a meniscal root avulsion of the attachment site. Our studies have also demonstrated that repairs of these radial root tears can restore fairly normal weightbearing characteristics and load sharing of the affected compartment. Thus, in properly selected patients, a radial root repair would also be indicated.

Post-Op

Patients who have a meniscal root repair need to be non-weightbearing for 6 weeks after surgery. Physical therapy is initiated on the first day after surgery. Patients are limited in moving their knees to 90 degrees of knee flexion for the first two weeks after surgery and then after this time they may increase their knee motion. At six weeks after surgery, a partial protective weight bearing program is initiated and patients may slowly wean off crutches when they can ambulate without a limp. The use of a stationary bike may be also started. Patients should avoid impact activities, deep squats, squatting and lifting, and sitting cross-legged for a minimum of 4 months after surgery to protect the meniscus root repair.

Meniscus Root Tear FAQ

What is a meniscus root?

The meniscus root is where the main body of the meniscus attaches to the bone. There are meniscal root attachments both in the front and back of the tibia.

What is a meniscus root tear?

A meniscus root tear happens when the root attachment is torn or destabilized. Most meniscus root tears actually are not the root tearing, but actually a tear of the meniscus within 1 cm of the root. These are called radial root tears and are about 90% of all meniscal root tears. A meniscus root tear can totally destabilize the shock absorbing function of the meniscus and can lead to insufficiency fractures, spontaneous osteonecrosis of the knee (SONK) and early onset arthritis in patients.

Meniscus root tear versus sprain?

Meniscus root tears can be either complete or partial. Our classification has called a partial root tear as a type 1 tear, and these can usually be trimmed without any significant consequence to the knee. Complete radial tears, which are type 2 tears, always should be considered for repair in patients who may need them, to prevent the development of osteoarthritis.

Meniscus root tear versus IT band syndrome?

Iliotibial (IT) band syndrome usually occurs on the outside of the knee over the bony bump called the lateral epicondyle. It is usually an overuse problem due to repetitive running in patients who have a tight iliotibial band. As such, iliotibial band friction syndrome usually does not occur until an athlete has been running for around 2 miles when the pain will start on the outside of the knee.

A medial or lateral meniscus root tear usually has pain within the center of the knee. These tears hurt with deep squatting or flexion activities and often lead to joint line pain. These symptoms are usually totally different between iliotibial band syndrome and meniscus root tears.

Meniscus root tear versus patellofemoral symptoms

It is not uncommon for patients who are in their 50s or 60s with meniscus root tears to also have concurrent patellofemoral chondromalacia (a kind term for arthritis). Thus it is important to differentiate the location of the pain in the knee to determine if it is coming from a potential meniscus root tear or from the patellofemoral arthritis. Usually, patients with pain in their kneecap joint have pain with squatting and lunges right on the front of their knee, whereas patients with meniscal root tears usually have pain in the very back of the knee, especially with deep squatting activities. In addition, patients can have the meniscus slip out of the joint, called extrusion. This can also sometimes be quite painful and can help to differentiate between patients who may have some preexisting patellofemoral arthritis (kneecap arthritis) and those that may have a meniscus root tear.

Learn How We Can Help You Stay Active

Robert LaPrade, MD, PhD has specialized skills and expertise in diagnosing and treating complicated knee injuries. He has treated athletes at all levels, including Olympic, professional and intercollegiate athletes, and has returned numerous athletes back to full participation after surgeries. Recognized globally for his outstanding and efficient surgical skills and dedication to sports medicine, he has received many research awards, including the OREF Clinic Research Award considered by many a Nobel Prize in orthopedics. Dr. LaPrade is one of the most published investigators in his field, and many of the surgeries that he has developed are now performed worldwide and recognized as the “gold standard” for the treatment of complex knee injuries.

I struggled with my knee for 18 months - having gone from 10,000 steps a day to only walking as needed. Previous attempts to make it better provided only temporary relief. (including injections and arthroscopic surgery), I heard Dr. La Prade was going to practice in the Twin Cities - where I live, & waited for him, based on his renown reputation. I am so glad I did! Dr LaPrade performed a deep root repair to my meniscus, which saved me from a knee replacement at this time. I am 5-months post surgery, and am doing great, stationary biking and exercising every day, no pain.You know you are seeing the best when you find out he has written over 500 medical journal articles - among many other accomplishments. Hey - if he is good enough for Olympic and professional athletes…..he's good enough for me! Thank you, Dr. LaPrade, for treating me with the care, focus, and expertise as if I was an Olympic athlete!- From your 63 year old very appreciative patent ~

Dr. Robert F. LaPrade operated on my right knee in May of 2010. I was hit by a car on my bicycle near Horsetooth Reservoir in CO. I was life flighted to MCR in Loveland, CO. My orthopedic injuries were severe, but totally missesd by the orthopedic team at Poudre. I could not bear weight on my right side though I tried repeatedly, but finally I went and got an MRI and one of the orthopedic surgeons that I worked with was shocked when he saw the MRI result. My right knee was totally destroyed; ACL, MCL, PCL all severely torn; the patella was the only thing intact in my right knee. Dr. La Prade had just moved to Vail and I was his 2nd patient @ The Steadman Clinic. I was told by one of the orthopedic surgeons that I worked with that I would never run again and would be lucky if I could ever hike again. This was devastating news after being a top triathlete (3rd in the world in my age group in 1989 & 1st nationally in my age group) and a big marathon runner. All I can say is Dr. La Prade did an amazing job and I am not limited in any of my activites. I can run, bike, & climb mountains. In fact 2 years ago I finished climbing the top 100 peaks in CO.

RELATED LINKS

Physician Rating

I struggled with my knee for 18 months - having gone from 10,000 steps a day to only walking as needed. Previous attempts to make it better provided only temporary relief. (including injections and arthroscopic surgery), I heard Dr. La Prade was going to practice in the Twin Cities - where I live, & waited for him, based on his renown reputation. I am so glad I did! Dr LaPrade performed a deep root repair to my meniscus, which saved me from a knee replacement at this time. I am 5-months post surgery, and am doing great, stationary biking and exercising every day, no pain.You know you are seeing the best when you find out he has written over 500 medical journal articles - among many other accomplishments. Hey - if he is good enough for Olympic and professional athletes…..he's good enough for me! Thank you, Dr. LaPrade, for treating me with the care, focus, and expertise as if I was an Olympic athlete!- From your 63 year old very appreciative patent ~

"Dr Laprade operated me after my father took me to the Steadman Clinic, and having been operated once before in MX, he rebuilt my knee and made me fully functional since then. A very human Physician, and incredible care." - Galia S.

DISCLAIMER All information contained on the drrobertlaprademd.com website is intended for informational and educational purposes. The information is not intended nor suited to be a replacement or substitute for professional medical treatment or for professional medical advice relative to a specific medical question or condition. (Website Terms and Conditions , Privacy Policy and Industry Relationships) Copyright | Robert LaPrade, MD, PhD | All Rights Reserved